{"id":5520,"date":"2014-10-19T09:16:45","date_gmt":"2014-10-19T13:16:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=5520"},"modified":"2015-06-04T14:32:02","modified_gmt":"2015-06-04T18:32:02","slug":"almost-filovirus-free-that-is-ebola-free-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/almost-filovirus-free-that-is-ebola-free-id-link-o-rama\/2014\/10\/19\/","title":{"rendered":"Almost Filovirus-Free (That is, Ebola-Free) ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/10\/insufferable-on-facebook1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-5531\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/10\/insufferable-on-facebook-300x2251.jpg\" alt=\"insufferable on facebook\" width=\"300\" height=\"225\" \/><\/a>If you&#8217;re an ID doctor right now, the\u00a0filovirus of the moment Ebola is consuming a big chunk of all of your non-clinical time &#8212; and this is particularly true for those heavily involved in\u00a0Infection Control, who\u00a0are spending every waking hour responding to public hysteria, to various\u00a0clinicians who seem\u00a0to have all the answers, and to ever shifting federal, state, and regional guidelines. Thank you for doing this!<\/p>\n<p>So as change of pace, I bring you this Almost Filovirus-Free ID Link-o-Rama, though this ever-challenging\u00a0epidemic\u00a0does make an appearance at the end.<\/p>\n<ul>\n<li>There&#8217;s been a bit of controversy on mandatory flu shots for certain healthcare workers at a certain New England hospital, whatever <a href=\"http:\/\/www.bostonglobe.com\/metro\/2014\/09\/24\/nurses-union-sues-block-proposed-flu-shot-mandate-brigham-and-women-hospital\/SQBXdxd1OQwTie5Fyg1d1J\/story.html\" target=\"_blank\"><strong>that could be<\/strong>.<\/a>\u00a0In response, I offer <strong><a href=\"http:\/\/www.medscape.com\/viewarticle\/833180\" target=\"_blank\">this brilliant Mark Crislip essay<\/a>\u00a0<\/strong>(it&#8217;s actually more of\u00a0a tirade),\u00a0which is republished annually by him and <strong><a href=\"http:\/\/www.skepticalraptor.com\/skepticalraptorblog.php\/dumb-asses-flu-vaccine\/\" target=\"_blank\">quoted by others<\/a><\/strong>, and falls easily into the <em>must read now<\/em> category &#8212; you will laugh, you will cry, and if you&#8217;re a health care provider you will nod your head with recognition many times, wishing you had the guts to write it yourself.<\/li>\n<li>Speaking of vaccines, this coverage of <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6341a1.htm\" target=\"_blank\"><strong>national immunization rates for children in kindergarte<\/strong>n<\/a> reminds us that while vaccine refusers can dangerously cluster within communities, overall the USA is still doing quite\u00a0well &#8212; which is why our outbreaks of vaccine-preventable illnesses are comparably small compared with Western Europe. School regulations\u00a0requiring vaccination before school entry is policy for the public good at its best &#8212; it&#8217;s what you&#8217;d expect an ID doctor married to a <strong><a href=\"http:\/\/hydeparkpedi.com\/staff\/carolyn-sax\/\">pediatrician<\/a><\/strong> to say, but so be it.<\/li>\n<li>Enterovirus 68 &#8212; which is now known as <strong><a href=\"http:\/\/www.cdc.gov\/features\/evd68\/\" target=\"_blank\">Enterovirus D68<\/a><\/strong> &#8212; is feeling a bit left out of the Panic Virus Hysteria, but here&#8217;s some good news: there&#8217;s a\u00a0<strong><a href=\"http:\/\/www.washingtonpost.com\/news\/post-nation\/wp\/2014\/10\/14\/faster-lab-test-will-check-for-rare-respiratory-virus-which-means-a-surge-in-confirmed-cases-is-coming\/\" target=\"_blank\">faster, better test<\/a><\/strong>\u00a0to diagnose\u00a0the infection, which will no doubt\u00a0give a much better sense of the full\u00a0spectrum of disease, and whether it is truly linked to neurologic syndromes.<\/li>\n<li>Kudos to my friend, colleague, and co-ID fellow (don&#8217;t ask when) Libby Hohmann, whose <strong><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1916296\" target=\"_blank\">study of &#8230; um &#8230; ingesting frozen poop pills<\/a><\/strong>\u00a0(that&#8217;s the easiest way to say it) for C diff points to a\u00a0future treatment of this nasty condition. Sure beats having a colonoscopy (prep and sedation) or a nasogastric tube (mega-yuck) for delivery of the required donor material.<\/li>\n<li>On the inpatient ID side, <em>Staph aureus<\/em> MICs <strong><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1913620\" target=\"_blank\">may not matter after all<\/a>.<\/strong> If you combine this result with the lack of clinical studies correlating vancomycin levels with outcome, and the fact that every ID fellow spends a big chunk of his\/her energy chasing these levels until they are perfect, can we have some sanity on this vanco level issue please?<\/li>\n<li>And while we&#8217;re talking about our oh-so familiar foe\u00a0<em>Staph aureus<\/em>, and in particular MRSA, <strong><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1911334\" target=\"_blank\">this editorial suggests we\u00a0reconsider patient isolation<\/a><\/strong> for this infection and for VRE. Seems it&#8217;s\u00a0probably unnecessary &#8212; with several major medical centers (Cleveland Clinic, Dartmouth-Hitchcock Medical Center, Detroit Medical Centers, others) already stopping this practice. Boy that would be liberating.<\/li>\n<li>That editorial was\u00a0part of a fun-packed <em>JAMA<\/em> issue that was <strong><a href=\"http:\/\/jama.jamanetwork.com\/issue.aspx?journalid=67&amp;issueid=930937\" target=\"_blank\">completely devoted to Infectious Diseases<\/a><\/strong>, including a study showing that around half of all hospitalized patients receive at least one dose of an antibiotic. And the most commonly prescribed drug? Vancomycin, followed (in order) by ceftriaxone, piperacillin-tazobactam, then levofloxacin. I wonder what proportion of patients admitted to a medical service get a cardiac ECHO?<\/li>\n<li>Guess what? Measuring CD4 cell counts in stable HIV patients on suppressive treatment<strong> <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.12198\/abstract;jsessionid=80013AD37CA0AAA87720D74663234DA9.f04t02\" target=\"_blank\">doesn&#8217;t influence treatment decisions.<\/a>\u00a0<\/strong>No surprise.\u00a0The problem, of course, is convincing our patients that the test we&#8217;ve been doing for all these years is no longer relevant &#8212; easier said than done!<\/li>\n<li>OK, Filovirus time. The policy\u00a0of treating all US Ebola virus disease patients in special biocontainment units has not as far as I can tell been formally enacted, but that&#8217;s what&#8217;s currently happening. There&#8217;s been some confusion about the capacity our system has for doing so, as not all the beds in all the units can be occupied simultaneously, but it seems that <strong><a href=\"http:\/\/abcnews.go.com\/Health\/us-capacity-11-ebola-patients-specialized-hospitals\/story?id=26251721\" target=\"_blank\">it&#8217;s a grand total of 11 beds<\/a><\/strong>\u00a0&#8212; the NIH has 2, and Emory, Nebraska, and Montana each has\u00a03.<\/li>\n<\/ul>\n<p>Department of Shameless Self Promotion: \u00a0You can now sign up and get notification about the latest post\u00a0by putting your email address in the box on the right. Not saying you want to do this, just that you can.<\/p>\n<p>And while we&#8217;re on the topic of self promotion, here&#8217;s a painfully funny takedown of <a href=\"http:\/\/waitbutwhy.com\/2013\/07\/7-ways-to-be-insufferable-on-facebook.html\" target=\"_blank\">egregious Facebook behavior<\/a>. Don&#8217;t complain that you weren&#8217;t warned &#8212; because we&#8217;ve all been there, done that.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you&#8217;re an ID doctor right now, the\u00a0filovirus of the moment Ebola is consuming a big chunk of all of your non-clinical time &#8212; and this is particularly true for those heavily involved in\u00a0Infection Control, who\u00a0are spending every waking hour responding to public hysteria, to various\u00a0clinicians who seem\u00a0to have all the answers, and to ever [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9],"tags":[162,302,329,365,630,984],"class_list":["post-5520","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-cd4","tag-ebola","tag-enterovirus-d68","tag-flu-vaccine","tag-mrsa","tag-vre"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5520","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=5520"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5520\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=5520"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=5520"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=5520"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}